慢性骨髓炎的治疗

目的探讨不同手术方法对慢性骨髓炎的治疗效果. 方法对38例慢性骨髓炎患者进行治疗观察,其中彻底病灶清除残留骨腔大者,以肌瓣或肌皮瓣填塞5例,无大骨腔者闭合伤口抗菌素灌洗25例,Orr＇s疗法5例,病骨切除3例.结果经随访1～15年,5例肌瓣填塞均Ⅰ期愈合;灌洗25例,24例愈合,1例愈合2年后复发;病骨切除3例均Ⅰ期愈合;Orr＇s疗法在3～5个月愈合4例,1例跟骨术后1年仍有分泌物.结论彻底清除炎性病灶是治愈慢性骨髓炎的关键措施,跟骨病灶较难彻底清除,是未愈的主要原因.有大骨腔者肌瓣填塞,无大骨腔者灌洗治疗可1次愈合.Orr＇s疗法,可在5个月内愈合,适于无肌瓣填塞的部位.     

Extramedullary fat fluid level on MRI as a specific sign for osteomyelitis

The role of MR in the early diagnosis of acute osteomyelitis is well known. In the context of florid cellulitis, abnormalities of marrow signal are not uncommon, although they are often non‐specific. Marrow oedema and enhancement in the context of deep cellulitis might reflect either reactive marrow oedema or true osteomyelitis. More specific signs lend favour to the diagnosis of osteomyelitis: these include focal bone destruction, periosteal reaction and sequestra. The observation of an extramedullary fat‐fluid sign is also a specific sign for osteomyelitis, as illustrated in the following case report. This sign is an indication of cortical breach and, thus, in the setting of infection and in the absence of trauma confirms the presence of osteomyelitis. To our knowledge, this additional specific sign of osteomyelitis has not been previously reported on MR.     

Unusual suppurative complications of brucellosis in children

Three cases with suppurative complications of Brucella melitensis infection are presented, demonstrating localized involvement of the brain, bones and lungs, respectivcly, and the lesions were well defined on radiographic examination. The diagnosis was made on the basis of significant Brucella titres and positive blood culture. Awarness of such complications and performance of the appropriate serological and bacteriological studies will establish the diagnosis and will also differentiate this discase from other infections, especially tuberculosis.     

Tuberculous osteomyelitis: an unusual case of tuberculous infection in a child undergoing continuous ambulatory peritoneal dialysis

A 10-year-old boy on continuous ambulatory peritoneal dialysis had low-grade fever, pain and tenderness of the right shoulder; he had no history of infection or exposure to tuberculosis. The underlying granulomatous infection was diagnosed by histological examination of bone and the polymerase chain reaction with primer sequences specific forMycobacterium tuberculosis. Special stains and cultures were negative. The initiation of antituberculous therapy was followed by a sharp improvement in the fever, malaise and shoulder pain within several weeks. Extrapulmonary tuberculosis is common in patients with chronic renal failure on dialysis and the diagnosis is difficult. The clinician must recognise the high and early mortality rate in order to initiate an aggressive diagnostic approach and early therapy.     

Management of chronic osteomyelitis of the skull using vascularized omental transfer

A case of chronic osteomyelitis of the skull with a large scalp and bony defect is presented. Following radical debridement, a vascularized flap of omentum was used for coverage, in conjunction with antibiotics administered intravenously. Some basic considerations in the management of osteomyelitis are discussed, as are the advantages of omentum as a material for scalp replacement.     

Pitfalls of computed tomography in diagnosis of discitis

Summary Sixteen patients with discitis from January 1980 through December 1983 underwent 18CT scans for initial evaluation. In six scans the study produced a false negative result (sensitivity 63%, 11/16). In three of these six the scan was performed at the wrong disc level, and in three the error was interpretive. During the same time period 6 patients had a CT diagnosis of discitis which proved incorrect (positive predictive value 63%), three of which had fractures, two had normal post discectomy changes, and one had a neuropathic arthropathy. These studies were reviewed in a blinded fashion along with 30 CT scans of post operative patients without clinical or laboratory evidence of discitis. The CT findings in the discitis patients were: (a( anterior paravertebral soft tissue swelling with obliteration of paravertebral fat planes, (b) fragmentation or erosions of vertebral end plates, and (c) paravertebral fluid collection (abscess). Both (a) and (b) were seen in 13/15 patients, (a) alone in 1/15, (b) alone in 1/15, and all three (a, b, c) in 2/15. The CT scan is diagnostic of discitis in those with all three findings. In those patients with only (a) or both (a) and (b), the CT can be suggestive of discitis in the proper clinical setting when correlated with plain film findings: however, these CT findings are also observed in other conditions. Involvement of the spinal canal by inflammatory mass was seen in 6/16 patients with discitis. Low attenuation (hypodensity) of the affected disc was not observed.     

大网膜游离移植修复慢性骨髓炎合并皮肤缺损

为了总结大网膜游离移植修复慢性骨髓炎合并皮肤缺损的临床效果，对１９８３年～１９９２年所作的１２例进行了随访观察。其中颅骨５例，胫腓骨４例，足跗骨３例，经彻底清除病灶后，均遗留有部分骨缺损或皮肤软组织缺损。采用吻合血管的自体大网膜移植充填缺损，其表面用中厚皮片移植覆盖。经３～９年随访，１１例无骨髓炎复发，无腹部并发症；１例术后４个月复发，并出现颅内高压症状，术后１年死于鳞状上皮癌     

Hahn's Operation for Pseud Arthrosis After Osteomyelitis of the Tibia in Children: A Report of Three Cases

Three children with pseudarthrosis of the tibia after osteomyelitis and extensive sequestration of the diaphysis were operated according to Hahn with transfer of the fibula to the proximal part of the tibia at ages 2-9 years. Because of damage to the distal growth plate, secondary to the infectious process, epiphyseodesis of the proximal ends of the tibia and fibula on the unaffected side was necessary to reduce the length discrepancy. Restored continuity of the tibial diaphysis resulted in restored longitudinal growth proximally and in increased diaphyseal width. in all three cases the operation resulted in good weight-bearing limbs with only slight residual disability at adult age. Hahn's original method is simpler and in children may result in a limb which is closer to normal than the modifications of his method.     

Multimodality imaging of osteomyelitis

Early diagnosis of osteomyelitis continues to be a clinical problem. Multiple imaging modalities are being used for the diagnosis of osteomyelitis, but none of them is ideal for all cases. The choice of modality depends on several factors based on an understanding of the pathophysiologic aspects of different forms of osteomyelitis. After a brief introduction outlining some basic principles regarding the diagnosis of osteomyelitis, pathophysiologic aspects are reviewed. Advantages and disadvantages of each imaging modality and their applications in different forms of osteomyelitis are discussed. The use of different imaging modalities in the diagnosis of special forms of osteomyelitis, including chronic, diabetic foot, and vertebral osteomyelitis, and osteomyelitis associated with orthopedic appliances and sickle cell disease is reviewed. Taking into account the site of suspected osteomyelitis and the presence or absence of underlying pathologic changes and their nature, an algorithm summarizing the use of various imaging modalities in the diagnosis of osteomyelitis is presented.     

MRI对儿童急性化脓性骨髓炎的早期诊断和治疗的指导价值

目的　探讨MRI对急性骨髓炎的早期诊断和治疗价值。方法　选择 16例下肢骨髓炎的患儿 ,在发病后第 2～ 14d行MRI扫描。结果　 15例患儿骨髓腔内均呈现异常MRI信号 ,病程越长者 ,病变与正常骨髓间分界越清晰 ,骨髓内病变呈斑片状稍长T1低信号和长T2 高信号 ,在短时反转恢复STIR序列上这种信号改变尤为明显。据MRI的表现分为脓肿型和无脓肿型 ,对脓肿型进行手术治疗 ,无脓肿型采用了非手术治疗 ,治愈率为 10 0 %。结论　MRI对急性骨髓炎的早期诊断和指导治疗具有重要意义